MIDDLEBURY — Porter Medical Center officials on Friday morning indicated that Helen Porter Nursing & Rehabilitation is not in imminent peril of closing in spite of its ongoing budget shortfalls, but said the facility will be in serious financial trouble going forward if state regulators maintain that Porter can no longer partially subsidize the service through its hospital budget.
Porter Hospital officials on Tuesday, Sept. 29, will lobby the Green Mountain Care Board (GMCB) to reconsider its recommendation to pare back the hospital’s Fiscal Year 2021 budget request because it in part floats operations at Helen Porter  — Addison County’s nursing home.
The hospital in August asked the GMBC to green-light a fiscal year 2021 budget of $92.3 million to cover its expenses, an increase of $2.1 million compared to this year’s spending plan, which sustained major revenue hits from the COVID-19 pandemic.
PMC officials requested a 5.75% increase citing, in part, the Helen Porter factor. GMBC instead granted a 4% bump that includes a 1% allowance for COVID-19 services.
As part of its spending plan, the hospital had sought permission for a 2.7% increase in net revenues — around $2.3 million — in order to deliver health care to Addison County residents next year. The spending plan was not poised to increase inpatient or outpatient fees next year, according to the hospital’s presentation to the GMCB.
The GMBC instead has asked Porter to reduce its net patient revenues ask to 2.1%.
It’s a directive that has raised serious concerns among officials at both PMC and University of Vermont Health Network (UVMHM) — of which Porter is an affiliate. The GMCB has had a long history of approving past Porter Hospital budgets that have included a Helen Porter subsidy, a service that PMC officials argue is critical to the cradle-to-grave continuum of health care in Addison County.
“As a hospital community we are struggling with the degree to which the GMCB seems to be straying from its charge,” PMC interim President Tom Thompson said on Friday, but added they would do everything they could to keep Helen Porter operating. “We’ve had no discussions about closing Helen Porter,” he said.
Porter spokesman Ron Hallman metaphorically likened the hospital’s overall financial burden to carrying a heavy bag of rocks. Each year, he said regulators seem to add another rock.
“At some point, that bag is going to break,” he said.
Thompson said he’s concerned about the long-term future of Helen Porter if the GMCB endorses a paradigm shift in the manner in which hospital budgets are evaluated.
The nursing home’s fiscal year 2019 expense budget was $12,326,573, while its operating loss that year was $2,437,146. Helen Porter during the past few years has consistently recorded annual losses of more than $2 million, according to Hallman. Losing the ability to subsidize Helen Porter through the hospital budget would create around a $500,000 problem in the short-term, according to Thompson.
At the same time, Helen Porter is saving the overall health care system big money by allowing patients a less costly place to convalesce (and get rehab) from injuries, than would be possible at the hospital.
The daily rate of Medicare reimbursement for a Helen Porter patient is now around $550, according to Bertrand. The cost of housing that same patient at Porter Hospital would be  $1,968 to $2,800, she said.
“There’s a huge savings to the system in terms of cost-of-care perspective,” Bertrand said.
Thompson echoed that perspective.
“Helen Porter serves our mission,” he explained. “The availability of our post-acute services at Helen Porter specifically enable us to reduce (more expensive) stays at the hospital for folks, and people have a safer and healthier transition back to their daily lives because of that asset.”
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In earlier comments on Thursday, Porter officials had also objected to the GMCB’s sudden change in how it accounted for Porter’s overall budget. 
“Porter Hospital’s budget was submitted in complete alignment with established guidelines and benchmarks and should not have been reduced,” reads a narrative from which Porter officials will address the GMCB on Tuesday. “The (GMCB) board’s deliberations reveal that the proposed hospital budget cut was driven largely by a desire to limit support for Helen Porter Nursing and Rehabilitation, a benchmark not previously articulated. As a result, Addison County is now at risk of losing this treasured resource.”
Porter Medical Center — which includes the hospital, Helen Porter Rehabilitation & Nursing and around a dozen affiliated physicians’ offices — currently employs around 800 full- and part-time workers.
Officials at University of Vermont Health Network (UVMHM) — of which Porter is an affiliate — were candid in their opposition to the board’s directive on Porter, as well as its general approach to hospital budgeting this year, which has been greatly impacted by the COVID-19 pandemic.
Dr. John R. Brumsted, president and CEO of UVMHN, shared his concerns in a Sept. 23 letter to the GMCB.
“… The Green Mountain Care Board’s (GMCB’s) budget review process has become untethered from the equitable, legal, and financial principles that should guide it, resulting in a series of budget decisions that will harm Vermont’s patients and hospitals at a time when they are already vulnerable due to the COVID-19 pandemic,” Brumsted wrote. “As established by statute, the GMCB is charged with overseeing the annual hospital budget review process in order to promote the health of the population and patient experience, reduce costs, and “achieve administrative simplification in health care financing and delivery.  Through its FY 2021 hospital budget process and decisions, the GMCB has done the very opposite, jeopardizing patient care and adding to the uncertainty and burdens facing hospitals.
“Additionally, through these decisions, the Board has undermined one of the fundamental tenets of the All-Payer Model (APM), which is our State’s established health care reform plan and our mechanism for achieving a health care system Vermonters can afford,” he added.
On Porter, Brumsted said “the board has never before relied upon this support to reduce Porter Hospital’s operating budget. Nor, prior to deliberations, did it suggest that it would do so this year.”